The U.S. may boast the world's largest economy on one hand and a deeply problematic president on the other. But under the surface, things are bleak.

There's something rotten in Trump's United States of America. No, I'm not talking about corruption cases, conflicts of interest or Russian inference, but rather the dashed hopes and declining quality of life for large sections of the population.

The United States is the world's largest economy. And yet, 40 million Americans live in poverty, while life expectancy and infant mortality rates are worse than in other developed democracies. These aren't new problems, but the ramifications are becoming more serious every day. Let's look, then, at what's been taking place there.

The first piece of the puzzle is the increasing wealth disparity over the last 40 years. The richest 1% went from holding 10% to 20% of the national wealth while the annual income of middle-class households barely progressed.

Princeton economists Anne Case and Angus Deaton identify a second key factor in a revolutionary article about the rising death rate among middle-aged whites (aged 45 to 54). The rate is especially high for deaths from suicide, alcoholism, and drugs, which Deaton and Case call "deaths of despair."

Unlike other economically similar countries, whose mortality rates within this group have continued to decrease, in the United States, it has increased since the late 1990s. The high mortality rate is especially high among less educated whites, namely those who lack a four-year university degree.

A third piece of the puzzle relates to the U.S. healthcare system and the overprescription of opioids. There are 10 opioid-related fatalities for every 100,000 people in the United States. In West Virginia, the rate of opioid overdoses is four times that. While it is true that these deaths of despair existed before the introduction of oxycontin, there is no doubt that opioids have dramatically accelerated the process.

Cycle of despair

Then there's the job market. Case and Deaton demonstrate that there is no significant correlation between monthly income (or the risk of unemployment) and mortality. This suggests a spiritual and moral crisis rather than purely economic problem, though there's clearly a lot of overlap in all of this.

Alan Krueger recently analyzed the declining participation rate in the U.S. job market. From 67.3% in 2000, participation in the job market fell nearly 5% to 62.4% in 2015. The United States now has the second lowest participation rate of any OECD country, behind Italy. Half of unemployed, working-aged men, furthermore, take daily pain medications. This matches the global pattern in which countries with higher rates of opioid overprescription have lower participation in the labor force. The labor and opioid crises are thus deeply interrelated.

It is estimated that half a million Americans are addicted to heroin and 80% of them started by abusing opioids.

Reversing this vicious cycle is, quite obviously, an immense challenge. When confronted with this health crisis, authorities limited public access to opioids. But it appears these restrictions have forced users to seek out other drugs and sources. In fact, researchers have linked the spectacular increase in heroin overdoses to the restrictions placed on oxycontin. It is estimated that half a million Americans are addicted to heroin and 80% of them started by abusing opioids.

The cherry on top of this poisonous cake is a synthetic opioid called fentanyl, which is more powerful than morphine and often mixed with heroin. Fentanyl overdoses have increased 540% since 2015. One of its many victims was the singer Prince, in 2016. A kilogram of fentanyl can be purchased in China for between $3,000 and $5,000, shipped through Mexico, and then resold for $1.5 million. With prices so high, the cycle becomes even harder to break.

The political lesson that stems from all of this is clear: Avoid this slippery slope at all costs. European countries are better protected by their social welfare systems. Nevertheless, they need to be on guard. Vigilance is of the utmost importance.